Action Plan for Critical Incident Investigation Report Recommendations

2019

Critical Incident Report Recommendations Summary July 04, 2019 Page 1

Many of the recommendations put forth in the Critical Incident Report are aligned with our current work that is underway at the Department of

Health and Social Services. We are committed to working with other government departments to enhance program and service delivery to our

patients.

Critical Incident Investigation

Report Recommendations

Current Status

Actions Taken

1. That the Government of Northwest Territories train community home support workers, particularly those providing support to Elders and individuals with disabilities to recognize acute medical conditions.

Ongoing All NWT regions organize annual educational opportunities for Home Support Workers (HSWs) and Long Term Care (LTC) staff including Elders in Motion, supportive care for clients with dementia, wound care, and palliative care training to name a few. Basic First Aid and CPR is also delivered annually by employers, staff are required to ensure they renew this training every three years.

In December 2018, the Northwest Territories Health and Social Services Authority (NTHSSA) organized a meeting where all HSW’s and LTC staff met to reinforce knowledge/education provided earlier in the year on elder care, disabilities, acute medical conditions and Supportive Pathways. In total, in 2018 Supportive Pathways was delivered in Yellowknife (x2), Ft. Simpson (x2), Norman Wells and Ft. Smith (x2). NTHSSA also has the following education planned for their HSWs and LTC staff:

May 2019 - Palliative Care 2 Day Course in Yellowknife for PSW’s/HSW’s/RCA’s/NA’s.

December 2019 - Continuing Care Conference for PSW’s/HSW’s/RCA’s/NA’s

January and March 2020 - two different palliative courses (LEAP and Integrating a Palliative Approach to Care). One session will take place in Inuvik and the other in Hay River for all staff.

Action Plan for Critical Incident Investigation Report Recommendations

2019

Critical Incident Report Recommendations Summary July 04, 2019 Page 2

2. That the Government of Northwest Territories explores opportunities for trained nurses to oversee home care programs and community home support workers.

Ongoing All HSWs now report to Community Care Managers. Regular scheduled meetings are held onsite to support opportunities for sharing and learning. In preparation for Accreditation these teams are exploring and implementing best practices, national standards and the development of standardized policies and procedures within the Authority. All regions have had their Nurses in Charge attended a NIC conference (in 2018) that provided education related to mentoring and supervising staff. As a result, NICs now hold regular meetings and education sessions. The Department is currently updating the NWT Community Health Core Service Standards and Protocols and we will be incorporating a standard focusing on Home Care. These standards will be released in summer 2019.

Action Plan for Critical Incident Investigation Report Recommendations

2019

Critical Incident Report Recommendations Summary July 04, 2019 Page 3

3. That the Government of Northwest Territories review and provide first responder training within the community of … to ensure standard medical care is provided at the earliest opportunity.

Ongoing First Responder Training is available through the Department of Municipal and Community Affairs (MACA)-School of Community Government. Training is provided upon request from the community government and commitment from community participants. Training courses, including First Aid, First Responder and Emergency Medical Response, can be hosted at a community, regional or territorial level. To date, the following training has been provided by the MACA –School of Community Government (2018/2019):

Course Location Date Attendance

Emergency Medical Responder

Hay River Jan 18 6

First Responder Tsiigehtchic Mar 18 2

Wilderness First Aid Yellowknife April 18 12

Wilderness First Aid Sambaa K’e May 18 14

Wilderness First Aid Fort Good Hope June 18 8

Standard First Aid Enterprise June 18 7

Emergency Medical Responder

Fort Smith June 18 10

Community Live Exercise (Airport Exercise - includes first responder component)

Wrigley Aug 18 10

Community Live Exercise (Airport Exercise - includes first responder component)

Hay River Sept 18 19

Community Live Exercise (Airport Exercise - includes first responder component)

Aklavik Nov 18 17

First Responder Ft. Simpson Jan 19 12

Community Live Exercise (Airport Exercise - includes first responder component)

Nahanni Butte Mar 19 7

Action Plan for Critical Incident Investigation Report Recommendations

2019

Critical Incident Report Recommendations Summary July 04, 2019 Page 4

4. That the Government of Northwest Territories review methods and practices of medical transportation within the community of … to ensure patients are transported to the health centre in a suitable and medically equipped ambulance.

Ongoing Oversight for ambulance service in the NWT is provided by MACA. The Department has partnered with MACA to review ground ambulance and highway rescue services. This work is ongoing as the management and delivery of this service in the NWT is challenging and complicated due to the large geographic area, low population base, and limited qualified volunteers in remote communities. MACA is currently working with community governments to assess fire protection capabilities, which also includes ambulance services.

External vendors were hired to complete a report on Ground Ambulance and Highway Rescue. This work was completed in late 2018 and a findings report was provided to the steering committee in January 2019. Unfortunately, the research and analysis in this second report served only to confirm the future work needed to clarify the operational and financial requirements necessary to sustain a desired service delivery standard. The Government of the Northwest Territories has accepted the Ground Ambulance and Highway Rescue Services Findings and Recommendations Report. A two year Action Plan has been developed based on the recommendations in the report, and an inter-departmental committee has been established to oversee implementation of the Action Plan. This interdepartmental committee will be chaired by MACA.

5. That the Government of Northwest Territories reviews and continuously monitors community health centres to ensure a full complement of health care providers.

Ongoing The Department of Human Resources works closely with the Health and Social Services Authorities (HSSAs) to ensure their staffing needs are met. When positions are not able to be staffed indeterminately or by a job share, they are filled with casual and locum staff. All staff are provided an orientation by the Nurse in Charge, the staff educator and/or the Manager of Community Health Centres. NTHSSA has developed a standardized mandatory onboarding process for all Community Health Centre (CHC) staff. All onboarding checklists and education is housed on their new CHC Website. They are actively tracking compliance with the mandatory programs to ensure everyone is receiving the same orientation.

Action Plan for Critical Incident Investigation Report Recommendations

2019

Critical Incident Report Recommendations Summary July 04, 2019 Page 5

6. That the Government of Northwest Territories review their Clinical Practice Guidelines for Primary Community Care Nursing as it relates to Cerebrovascular Accidents (Stroke) and ensure that all the community nurses follow it.

Ongoing Community Health Nurses use the NWT Clinical Practice Guidelines (CPGs) for Primary Community Care Nursing, as a tool for clinical guidance on assessment, interventions and treatment/referrals. These existing CPGs have a specific guideline for stroke management. The Department is in the process of updating the current CPGs. The Department has collaborated with subject matter experts and the stroke management CPG has been updated and approved. This CPGs evidenced based and includes the appropriate protocols for assessment and treatment. This evidenced based work will be shared with the HSSAs for dissemination to nursing staff in July 2019

7. That the Government of Northwest Territories review protocols at the Inuvik Hospital for dispatching medivacs including who is responsible to initiate the medivac and ensure this information is part of all orientation to new staff including all resident doctors in training.

Completed It has been established that all new employees in the emergency department at the Inuvik Regional hospital are orientated to the procedures and protocols related to Medivacs. Through the NTHSSA’s accreditation process, standardization in Med Response is occurring. An orientation to Med Response is included in the new standardized mandatory onboarding process for all NTHSSA CHC staff.

Action Plan for Critical Incident Investigation Report Recommendations

2019

Critical Incident Report Recommendations Summary July 04, 2019 Page 6

8. That the Government of Northwest Territories review triage coding protocols to ensure patients are coded appropriately and receive the standard of care associated with each code.

Ongoing The Canadian Triage and Acuity Scale (CTAS) is a nationally recognized tool that is used to assess patients and provides a clinical decision making process to correctly identify a patient’s needs, set priorities and implement appropriate investigation and treatment. CTAS scoring has been implemented across the Territory in acute care Emergency Departments. Audits are being completed by NTHSSA quarterly to ensure patients are seen within the timeframe for their CTAS score. Currently, Med Response is utilizing CTAS scoring for the triaging of all clients. All Health organization across the Territory, regardless of if it is a Health Centre or hospital, has access to the Med Response Program. The Tlicho Community Service Agency (TCSA) is in the process of arranging online CTAS training for staff. However, there is no current plan for full CTAS implementation across TCSA facilities. When not using Med Response’s assistance, both NTHSSA and TCSA use NTHSSA’s Walk-In Triage Policy in their Community Health Centre’s. This Policy outlines criteria for triaging individuals in a timely manner to determine immediate and urgent needs. If a client presents in distress or serious injury the Community Health Nurse is informed immediately. The Department is developing Community Health Centre Administrative Standards and will ensure there will be a standard for all nurses in community health center settings to be informed and trained in triage assessment and scoring.

9. That the Government of Northwest Territories reviews the charting process in the Inuvik Hospital with a view to improving the flow and documentation.

Completed In the NTHSSA Regions, including the Inuvik Regional Hospital, charting standards are in place. Each month charts in the emergency department are retrospectively audited for medication reconciliation, falls risk, and adherence to CTAS guidelines and tracking information.

Action Plan for Critical Incident Investigation Report Recommendations

2019

Critical Incident Report Recommendations Summary July 04, 2019 Page 7

10. That the Government of Northwest Territories explore establishing stroke protocols including directly transporting the patient to the Stanton Hospital in Yellowknife if there is a high suspicion of stroke so that there is appropriate treatment in a timely manner.

Ongoing The clinical pathway for stroke management is outlined for Community Health Centres in the CPGs followed by immediate correspondence with Med-response and ER physicians. The Department has collaborated with subject matter experts and the stroke management CPG has been updated and approved. This CPGs evidenced based and includes the appropriate protocols for assessment and treatment. This evidenced based work will be shared with the HSSAs for dissemination to nursing staff in late July 2019.

11. That the Government of Northwest Territories explores establishing a stroke centre at the Stanton Hospital in Yellowknife.

Completed The Department and NTHSSA have met with Alberta Health Services Neurologists to explore the feasibility of establishing a stroke centre at Stanton Territorial Hospital. Due to our geography, and the time to access care, precludes our ability to have a viable stroke center in the NWT at this time. As an alternate, stroke centre clinical guidelines will be established to ensure appropriate care and response is delivered in a standardized manner across the territory.

Action Plan for Critical Incident Investigation Report Recommendations

2019

Critical Incident Report Recommendations Summary July 04, 2019 Page 8

12. That the Government of Northwest Territories implements a process to respond to patient and family concerns related to the care that they receive within the health care system.

Ongoing The Department has established a Territorial System Quality Committee and is working with the three HSSAs to address and improve responses to patient and family concerns across the system. In March 2019, the Department sponsored 17 health and social service providers from across the NWT to attend four days of Investigation Training in Yellowknife, through the Justice Institute of British Columbia (JIBC). A territorial-wide electronic incident-reporting program is expected to be fully implemented in July 2019. This will help standardize and streamline the reporting and tracking of incidents. A standardized territorial complaints process that aligns with and links to appropriate legislation. Our goal is to have a system wide plan established before by the end of 2019. A draft quality framework has been developed by Northwest Territories Health and Social Services Authority (NTHSSA). Implementation of the full framework will be a phased in approach. NTHSSA is committed to ensuring this framework is operational in the coming months. This framework will give patients, clients and their families a central point of contact where they can raise concerns, ask questions and be provided timely response to their concerns. The framework will include a robust quality process for dealing with concerns, reviews, and investigations and for making recommendations on how we can improve the health and social services system. These recommendations will be monitored regularly to track progress.

The Client Experience Office will be established to give patients, clients and their families a central point of contact where they can raise concerns, ask questions and be provided timely responses. It is the intention that the Client Experience Office will be established in the Fall 2019.

o This office will be supported by the Quality Risk Management specialists

Action Plan for Critical Incident Investigation Report Recommendations

2019

Critical Incident Report Recommendations Summary July 04, 2019 Page 9

throughout the Territory.

o When the Client Experience Office is established public awareness materials and a robust communication campaign will be developed.

13. That the Government of Northwest Territories in partnership with communities, recruit and train Indigenous first responders, nurses, and physicians from within the communities and surrounding areas to decrease turnover and transiency, ensuring continuity of care. This is in keeping with number 23 in The Calls to Action of the Truth and Reconciliation Report.

Ongoing The recruitment of all GNWT employees and internships is done through the Department of Finance which follows the Affirmative Action Policy. The Department of Finance has programs available that all employees can apply on should they want or need training in a certain areas. MACA has developed a Volunteer Fire Fighter Recruitment and Retention Toolkit to all NWT communities. This toolkit provides volunteers, Fire Chiefs, senior administrative staff, and community governments with an overview of best practices to consider in the recruitment and retention of volunteer fire fighters. The toolkit is available on MACA’s website at the following location: http://www.maca.gov.nt.ca/sites/maca/files/volunteer-fire-fighter-recruitment-and-retention-toolkit.pdf Aurora College offers a Bachelor of Science in Nursing program. Their mission statement is focused on Student Success and is committed to supporting the development of our Northern Residents through excellence in education, training and research that is culturally sensitive and responsive to the people we serve. The Inuvialuit Regional Corporation has sponsored a two-year Practical Nursing program that started in September, 2018 in Inuvik and they have also extended funding for a new cohort of students to commence in September 2019. The Department of Education, Culture and Employment (ECE) provides financial assistance to eligible Northwest Territories residents to assist with postsecondary education-related expenses. This Student Financial Assistance (SFA) program assists to remove financial barriers that may exist for education.

Action Plan for Critical Incident Investigation Report Recommendations

2019

Critical Incident Report Recommendations Summary July 04, 2019 Page 10

14. That the Government of Northwest Territories develop and initiate policies for the implementation of mandatory and ongoing cultural safety training, with content designed and delivered in partnership with the Indigenous community, for all health care workers. Cultural safety training should be grounded in an anti-oppression framework and include concepts of unconscious and perception bias (racism), Indigenous view of family including next of kin. This is in keeping with number 23 in the Calls to Action of the Truth and Reconciliation Report.

Ongoing The Department in partnership with ECE, and Strategic Human Resources, is developing mandatory cultural competency training modules for all GNWT employees. The Department has developed the new Cultural Safety Action Plan 2018-2020 called “Caring for Our People”. This Action Plan outlines the following in regards to cultural safety training:

Key training activities for the 2019 year to improve the Health and Social Services system:

o Develop a toolkit to support culturally safe and respectful communication between staff and clients.

o Formalize a territorial compliments and complaints process to better understand client experiences to inform quality improvement.

o Pilot cultural competency training models to staff across HSS system.

The training will be provided with a sequenced approach. o The first step will focus on ensuring staff have completed the Government of

the Northwest Territories Indigenous Cultural Awareness Training. o The second step will focus on the delivery of pilot trainings. o The third step will focus on the roll-out of the final NWT cultural competency

training package in 2021.

Three pilot trainings have been held: one in December 2018 and two in January 2019. Two additional sessions were delivered in May, 2019.

o Two pilots focused on bias and building relationships in the workforce the third pilot focused on principles of cultural competency and safety.

o The May pilots will also focus on cultural competency and safety principles. As of April 2019, all CHC staff are required to complete mandatory Cultural Awareness training as part of their standardized onboarding process. The new Cultural Safety Action Plan training will be incorporated when it is released/finalized.

Action Plan for Critical Incident Investigation Report Recommendations

2019

Critical Incident Report Recommendations Summary July 04, 2019 Page 11

15. That the Government of Northwest Territories explores recruiting and retaining Indigenous Elders to work collaboratively on cultural safety training.

Ongoing The Department has developed the Cultural Safety Action Plan. The development of the ensuing training will include an advisory role for Indigenous Elders. As of April 2019, there is one advisory role filled at Stanton Territorial Hospital.

16. That the Government of Northwest Territories affect change within their health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients. This is in keeping with number 22 in the Calls for Action of the Truth and Reconciliation Report.

Ongoing The GNWT has supported the efforts of the Arctic Indigenous Wellness Foundation (AIWF) to establish an Indigenous Healing Centre at the Stanton Territorial Hospital Campus with the goal of having traditional healing available to all Indigenous patients in the future. The Arctic Indigenous Wellness Foundation celebrated its one year anniversary in April 2019. To date, the AIWF has worked on the following initiatives that have helped increase access to aboriginal healing practices:

Elder to Youth/Elder to Homeless Cultural and Skills Programming

Mental Wellness for Indigenous Boys and Men-Movember

Traditional Medicine Revitalization

Research Development in Indigenous Healthcare Delivery

Traditional Medicine & Food Gardening Program The Department has updated the NWT Community Health Core Service Standards and Protocols which will incorporate elements of Indigenous culture, healing, and traditional medicines. These Standards will be released in July 2019.